This document discusses the relationship between nutrition and periodontal health. It defines key terms like diet, nutrition, and malnutrition. It also classifies nutrients and discusses the roles of macronutrients like proteins, carbohydrates, and fats as well as micronutrients like vitamins and minerals. Specific nutrient deficiencies are linked to periodontal diseases. The document also explores how nutrition can impact the oral microbiome and periodontal biofilm formation. Finally, it concludes that while nutritional deficiencies do not directly cause periodontal disease, they can alter the body's resistance and repair mechanisms, affecting periodontal health.

1. GUIDED BY: PRESENTED BY:
DR. RUPINDER KAUR DR. VIRSHALI GUPTA

2. CONTENTS
• INTRODUCTION
• DEFINITION
• CLASSIFICATION
• LOCAL EFFECT OF DIET ON PERIODONTAL HEALTH
• INTERACTION OF IMMUNITY, INFECTION & NUTRITIONAL
STATUS
• NUTRITION AND PERIODONTAL HEALTH
INTERRELATIONSHIP
• EFFECT OF NUTRITION UPON ORAL MICROORGANISMS.
• HOST NUTRITION AND PLAQUE BIOFILM
• CONCLUSION
• REFERENCES

3. INTRODUCTION
• The diet plays primarily a modifying role in the progression of
periodontal disease.
• Nutrient deficiencies, excesses, or imbalances do not initiate
periodontal disease nor do mega doses of supplements cure or
prevent periodontal disease.
• However, nutrition may alter development, resistance, and/or
repair of the periodontium.

4. DEFINITIONS
• DIET : pattern of individual food intake, habit, kind and amount
of food eaten.
• NUTRITION: science of how the body uses food to meet its
requirement of growth, repair, development and maintenance.
• NUTRITIONAL STATUS : condition of health as it relates to food
and nutrient intake, absorption and utilization.
• MALNUTRITION: impaired health related to nutrient or caloric
deficiency, absorption, utilization or excretion.

5. BALANCED DIET
A BALANCED DIET is defined as one
which contains a variety of foods in such
quantities and proportions that the need
for energy, amino acids, vitamins,
minerals, fats, carbohydrates and other
nutrients is adequately met for
maintaining health, vitality and general
well being and also makes a small
provision for extra nutrients to withstand
short duration of leanness. – Park.
A balanced diet has become an accepted
means to safeguard a population from
nutritional deficiencies.

6. • In constructing balanced diet, following principles has to be
followed---
• Daily requirement of protein should be 15-20 % of daily energy
intake.
• Fat requirement should be limited to 20-30 % of daily energy
intake.
• Carbohydrates rich in natural fibers should constitute
remaining energy intake.
• Requirements of micronutrients should be met.

7. NUTRIENTS
• Organic and inorganic complexes contained in food.
• About 50 different nutrients are normally supplied through the
foods we eat.
• Each nutrient has specific functions in the body.
• Most natural foods contain more than one nutrient.
• may be divided into :
MACRONUTRIENTS MICRONUTRIENTS
proteins, fats, and
carbohydrates,
vitamins and minerals

8. PROTEINS
Complex organic nitrogenous compounds composing of carbon,
hydrogen, oxygen, nitrogen and sulphur in varying amounts.
Some proteins also contain iron and phosphorous.
Made up off smaller units called amino acids.
• SOURCES
• Animal sources– milk, meat, eggs, cheese, fish.
• Vegetable sources– pulses, cereals, beans, nuts, oil seeds.
• DAILY REQUIREMENT: 60-65 gms/day for adults.

9. • FUNCTIONS:
• Necessary for growth and repair of the body.
• Build up new tissues during the period of growth or pregnancy &
lactation.
• Required for the formation of digestive enzymes, hormones,
plasma proteins, hemoglobin and vitamins.
• Provide 10-15% of the energy during emergencies e.g.,
starvation, inadequate food intake.
• Act as buffers helping to maintain the PH of plasma at a constant
level.

10. PROTEIN DEFICIENCY & PERIODONTAL
DISEASE
• Degeneration of the connective tissue of the gingival and
periodontal ligament.
• Osteoporosis of alveolar bone.
• Retardation in the deposition of cementum.
• Delayed wound healing.
• Atrophy of tongue epithelium.
(Chawla & Glickman 1951)

11. CARBOHYDATES
• DAILY REQUIREMENT: 300-500 gm/day

12. FUNCTIONS
• Primary function is to provide a source of energy to facilitate
body metabolism (1200 kcal).
• Brain and nervous tissue utilize only glucose as energy source
(5 grams per hour).
• Muscles including the heart muscles derive energy for
contraction from stored glycogen.
• Protein sparing effect- adequate carbohydrate spare protein
during metabolism which can be utilized for growth and
repair of the body.
• Major components of the ground substance are derived from
carbohydrates.

13. FATS AND OILS
• Fats are solid at 20 deg c.
• Called oils if they are liquid at that temperature.
• Fats and oils are sources of energy.
• Fats yield fatty acids and glycerol on hydrolysis.
• Poly unsaturated fatty acids are found in vegetable oils and
saturated fatty acids in animal fats.
• Coconut oil and palm oil contain saturated fatty acids.
• SOURCES:
• Animal fats: ghee, butter, milk, cheese, egg, meat, fish.
• Vegetable fats: ground nut, mustard, coconut.
• Others: cereals, pulses, nuts, vegetables.

14. FUNCTIONS
• Provide energy -- 9 kcal every gram.
• Serve as vehicle for fat soluble vitamins.
• Act as thermal insulators for skin.
• Essential fatty acids are required for the body growth and
structural integrity.
• DAILY REQUIREMENTS:
• 10-20 gms/day

15. FAT AND ITS ROLE IN DISEASE
• OBESITY
• PHRENODERMA- deficiency of essential fatty acids in diet is
associated with rough and dry skin(toad skin )
• CORONARY HEART DISEASE
• CANCER
• ATHEROSCLEROSIS
• CHRONIC SWELLING OF PAROTID GLANDS due to
disturbances in lipid metabolism.

16. VITAMINS
• Vitamins are essential and biologically active constituents of a
diet.
• The absence or scarcity of certain vitamins has been implicated
as being a primary etiological factor in the pathogenesis of
periodontal diseases.
• Vitamins are divided into 2 groups:
• FAT SOLUBLE VITAMINS - A, D, E and K
• WATER SOLUBLE VITAMINS – B complex and C

17. VITAMIN A (RETINOL)
VITAMIN A AND PERIODONTAL DISEASE:
Deficiency: marginal gingivitis, gingival bone hypoplasia, pocket
formation, alveolar resorption . periodontal disease.

18. VITAMIN D AND PERIODONTAL DISEASE
• A small number of patients with evidence of rickets develop
enamel hypoplasia.
• The enamel does not appear to be weakened, but the rougher
surface may facilitate adherence of dental plaque and food
residue.
• No studies demonstrate a relationship b/w vit D def and
periodontal disease.

19. VITAMIN C
(ASCORBIC ACID)
• DAILY REQUIREMENT: around 30 – 40 mg per day

20. POSSIBLE ETIOLOGIC FACTORS:
• Low levels of ascorbic acid influence the metabolism of
collagen within the periodontium, affecting the ability of
tissue to regenerate or repair itself.
• Interferes with the bone formation, leading to loss of
periodontal bone.
• def can lead to defect in epithelial barrier.
• Megadoses of vit C seem to impair the bactericidal activity of
leukocytes.
• An optimal level of ascorbic acid is required to maintain the
integrity of periodontal microvasculature, as well as the
vascular response to bac plaque and wound healing.
• Depletion of vit C may interfere with the ecologic
equilibrium of bac in plaque and thus inc its pathogenicity.

21. ASCORBIC ACID AND PERIODONTAL DISEASE

22. VITAMIN E
ACTION OF THE NUTRIENT: anti oxidant and maintains cell
membrane.
• No effect on periodontal tissues.

23. VITAMIN K
• Daily requirement : about 0.03 mg/kg for the adult.
• DEFICIENCY:
• Prolonged clotting time and bleeding time.
• Gingivitis and periodontal disease.

24. VITAMIN B1
• The earliest symptoms of thiamin deficiency include
constipation, appetite suppression, and nausea as mental
depression, peripheral neuropathy, and fatigue.
• Chronic thiamin deficiency leads to more severe neurological
symptoms and to cardiovascular and musculature defects
(Winston et al. 2000).
• Oral manifestations include: hypersensitivity of oral mucosa,
under the tongue or on the palate, and erosion of the oral
mucosa.

25. VITAMIN B2 (RIBOFLAVIN)
• Symptoms associated with riboflavin deficiency include
glossitis, seborrhea, angular stomatitis, cheilosis, and
photophobia.

26. ANGULAR STOMATITIS CHEILOSIS
SEBORRHEA

27. VITAMIN B3 (NIACIN)
• A diet deficient in niacin leads to glossitis, dermatitis, weight
loss, diarrhea, depression and dementia.
• The severe symptoms of depression, dermatitis, and diarrhoea
are associated with the condition known as pellagra.
• Several physiological conditions (e.g. Hartnup disease and
malignant carcinoid syndrome) as well as certain drug
therapies (e.g. isoniazid) can lead to niacin deficiency
(Carpenter 1983).

28. FOLIC ACID
• Folate deficiency causes gingival enlargement.
• Lack and Thomson, studied the effects of supplementation with
folic acid on pregnancy gingivitis concluded that topical folate
application produces significant improvement in gingival health
compared to systemic administration and placebo.

29. TONGUE IN VITAMIN B DEFICIENCY
• Chronic glossitis has been associated with deficiency of most
of the B complex vitamins particularly niacin, riboflavin,
folic acid.
MAGENTA TONGUE SCARLET TONGUE BEEFY RED TONGUE
Riboflavin deficiency Niacin deficiency Vitamin B12 deficiency

30. MINERALS
• COPPER:
• A positive correlation has been demonstrated between serum
copper and severity of periodontal disease by Freeland et al in
1976.
• Copper is also essential for the development and maturation of
connective tissues. (O’Dell et al 1961).
• A copper metalloenzyme contributes to the stabilization of
collagen. (Burch et al 1975).
• Freeland et al (1976) suggested that if this enzyme accumulates
in blood or if copper is not transferred to the periodontal tissues,
then an elevation of serum levels of copper will result.

31. • ZINC:
• Zinc levels are found to decrease with an increase in alveolar
bone resorption. (Frithiof et al 1980).
• Zinc ions can stabilize the cell membranes of PMNs and inhibit
the release of lysosomal enzymes.
• The reduction in serum zinc in periodontal disease may stimulate
both leucocyte function and the release of potent enzymes, which
will enhance the inflammatory process and lead to loss of
periodontal collagen.
(Chapvil et al 1977).
• Kilgore et al. (1969) failed to find a relationship between serum
levels and periodontal status.

32. • CALCIUM AND PHOSPHATE:
• Hypocalcaemia and hypophosphataemia that result from dietary
imbalance of these ions will produce a nutritional, secondary
hyperparathyroidism, which initiates alveolar bone resorption.
• A hypocalcaemic diet can produce inter – radicular alveolar
osteoporosis and thinning of individual trabeculae but it will not
initiate inflammation, migration of the epithelial attachment, loss
of periodontal fibers or resorption of the alveolar margin –
Svanberg et al 1973.

33. LOCAL EFFECT OF DIET ON PERIODONTAL
HEALTH
• Vigorous masticatory function is associated with a widening of
the PDL. (Collidge 1937)
• Aukes et al (1987) suggest that chewing pattern depends on the
texture of the masticated food, hard and tough food requiring
more vertical movements and soft food requiring less vertical
movement.

34. INTERACTION OF IMMUNITY,
INFECTION AND NUTRITIONAL STATUS
• Nutrients interact with immune cells in the blood streams, lymph
nodes and specialized immune system of the gastrointestinal tract.
• Majority of nutrient deficiencies will impair the immune
response and predispose the individual to infection.
• Individuals who are undernourished have impaired immune
response including abnormality in adaptive immunity ,
phagocytosis and antibody function.
• Epidemiological and clinical data also suggests that nutritional
deficiencies alter immune responses and increase the risk of
infection.
(R.K. Chandra. Am J clin Nutrition 1997)

35. NUTRITION AND PERIODONTAL
HEALTH INTERRELATIONSHIP
• Periodontal destruction is a consequence of infection and a
nutritional deficiency alone is no longer believed to initiate
periodontal disease, it is more likely, that a state of malnutrition
will predispose a subject to onset of a periodontal infection, or
will modify the rate of progression of established disease.
(Glickman 1964, Ferguson 1969)

36. Food and nutrition affect periodontal health at 3 levels:
Contributing to microbial growth in gingival crevice
Affecting the immunological response to bacterial antigen
Assisting in the repair of connective tissue at the local site
after injury from plaque calculus and so forth

37. NUTRITION AND EPITHELIAL BARRIER
• Rapid rate of turn over of epithelial cells of gingival sulcus
indicates the need of continuous synthesis of DNA, RNA and
tissue protein.
• This indicates that sulcular epithelium has high requirement of
such nutrients as folic acid and protein which are involved in cell
formation.
• At the base of the sulcular epithelium is a narrow basement
membrane made up of collagen.
• Since collagen is the major component of basement membrane
and ascorbic acid and zinc are important for collagen synthesis.
• This membrane act as a barrier for entrance of toxic material.

38. THE EFFECT OF NUTRITION UPON ORAL
MICROORGANISMS.
• Although dietary intake is generally thought of in terms of
sustaining the individual it also source of bacterial nutrients.
Composition of the diet may influence the relative distribution
of types of microorganism their metabolic activity, their
pathogenic potential which in turn affects the occurrence and
severity of oral disease.
(Morhant & Fitzgerald 1976)

39. HOST NUTRITION AND PLAQUE BIOFILM
Nutrition has both direct and indirect effects on development and composition
of plaque biofilm
The biofilm is made up primarily of microorganisms that include bacteria. Fungi,
yeasts. and viruses
In addition, 20 to 3O% of the plaque mass is made up of intracellular matrix
consisting of organic and inorganic components
The organic components include polysaccharides, proteins, glycoproteins and
lipids.
Inorganic components are primarily calcium and phosphorus with trace
amounts of sodium, potassium and fluoride

40. An example of this is the introduction of excess glucose to a plaque biofilm which
has been shown to result in an increased rate of bacterial growth in the early
stages of biofilm development
The primary mechanism by which nutrition impacts the biofilm is through a
direct supply or specific nutrients (such as sucrose) as substrates for energy,
nitrogen, or carbon for the bacteria.
The secondary colonizers of the more mature plaque biofilm are anaerobic, gram
negative bacteria and use amino acids and small peptides as energy sources
The early bacteria colonizing the dental pellicle are aerobic, gram-positive and
primarily use sugars as an energy source

41. CONCLUSION
A well balanced diet is required for the normal growth and
development of an individual. Any increase or decrease of the
nutrients in the long run may lead to devastating situations.
There are nutritional deficiencies that produce changes in
the oral cavity. But, there are no nutritional deficiencies that by
themselves will cause these changes.
They can only affect the condition of the periodontium and
thereby aggravate the injurious effects of local factors and excessive
occlusal forces.

42. REFERENCES
• Satyanarayana U. Essentials of Biochemistry.
• MR Milward, ILC Chapple. THE ROLE OF DIET IN
PERIODONTAL DISEASE. Volume 52 No 3 of 6 May 2013
• Vasudevan DM, Sreekumari S. Text Book of Biochemistry. 3rd Ed.
• Carranza’s .Clinical Periodontology. 10th ed.
• Robert E. Schifferle. Periodontal Disease And Nutrition
Separating The Evidence From Current Fads. Periodontology
2000: vol.50: 2009, 78-89.
• Boyd LD, Theresa ME. Nutrition, infection and periodontal
disease. Dent Clin N Am 2003 ;47: 337 -354.